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Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While the ambulatory EHR market remains somewhat stable, the number of organizations preparing to get out of their existing system has climbed over previous years, along with an increase in the number of organizations prepared to upgrade their practice management solution, according to new data from HIMSS.

To conduct the 9th Annual Outpatient PM & EHR Study, HIMSS Analytics reached out to physicians, practice managers/administrators, practice CEOs/presidents, PAs, NPs and practice IT directors/staff. A total of 436 professionals responded to its web-based survey.

The survey concluded that 93% of hospital-owned outpatient facilities had a live, in-operation EMR in place. Meanwhile, 70% of respondents representing free-standing outpatient facilities said they had an EHR in place, down from 78% last year.

As part of its survey, HIMSS Analytics asked respondents whether they planned to purchase an entirely new ambulatory EHR system, replace the existing system upgrade the system within the next two years.

The responses suggest that there’s been some new movement in the ambulatory EHR market. Most notably, 10.6% of respondents said they plan to replace their current solution, up from 6.4% in 2014. This is arguably a significant change. Also, 23.8% respondents said they were upgrading their current ambulatory solution, up from 20.8% in 2014.

In addition, the number of respondents with no investment plans fell below 60% for the first time in four years, HIMSS Analytics noted.

Though the practice management system market seems to be a bit more stable, some churn appears to be emerging here as well. Eleven percent of respondents said they plan to upgrade their current PM solution, down from 20.8% in 2014, and 9.3% said they plan to replace their current system, up from 6.4% in 2014.

All in all, there’s not a great deal of replacement activity underway, though the data does suggest a small spike. That being said, I was interested to note that respondents’ willingness to invest in a new system was higher than their willingness to upgrade a system they have.

The question is, why would ambulatory providers be ready to junk their existing EHR and practice management solutions now as opposed to three years ago? Are we reaching the end of a grand health IT replacement cycle or is there more going on here?

One possibility is that with MACRA kicking in, outpatient providers have been forced to reevaluate their existing systems in terms of their ability to support participation in QPP. Another fairly obvious possibility is that ambulatory providers are choosing to systems they feel can support their movement into value-based care.

From what I can tell, providers choosing new systems for these reasons are actually a bit behind the curve, but not terribly so. When their peers attempt to push forward with their three, four or even five-year-old systems, then you may see a replacement frenzy. Sometimes you just can’t afford to stick with Old Faithful.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Almost every healthcare organization I meet is talking about how to get better adoption of their EHR software. They’ve implemented their EHR as part of a massive go live. Many are even doing fine with programs like meaningful use and are working on MACRA. However, they all realize that adoption of their EHR software by end users could be better than it is today.

During these conversations, it’s easy to see how some organizations slip into the thinking that if they replaced their EHR with a new one that somehow that would spur more adoption and EHR use by their end users. When you hear users complaining about EHR software, it’s easy to blame the software itself. This is a dangerous line of thinking because that’s just not how it works. Switching EHR software does little to improve adoption of EHR by end users. EHR adoption problems that exist with one EHR are likely to exist in any new EHR.

That’s not to say there aren’t legitimate reasons for you to switch EHR. There are many good reasons to switch EHR software including when your organization is bought out and you want to align EHR software or when your product is being sunset. These can be good reasons to switch EHR and there are many more. However, it’s usually a mistake to switch EHR when you don’t have a good strategic reason to switch and lack of adoption is not a good strategic reason to switch.

When EHR adoption is lacking in your organization, instead of considering switching EHR, look at doubling down on your existing EHR. Core to successfully “doubling down” is leadership. Heather Haugen highlights this fundamental principle in her whitepaper “Leadership Insights: Gaining Value from Technology Investments when she says, “Organizations with leaders who are fully invested in the daily march toward adoption will reach the early stages of adoption quicker and enjoy a reinforced cycle of meaningful clinical and financial outcomes.”

The most successful organizations I’ve seen are led by people who understand that EHR adoption is not a one time event, but is an ongoing process of workflow improvement, training, and process modification. The value an EHR can provide is extracted as organizations incrementally improve their use of the EHR. It doesn’t happen by accident or by happenstance. It requires thoughtful and well executed leadership.

The idea of replacing your EHR to improve EHR adoption and use is often just an easy way out from addressing the real reasons why EHR use in your organization is not optimal. When this happens, you’re still generally faced with the same hard challenges after replacing your EHR. Don’t fall into this trap in your organization. If there’s not a strategic reason to replace your EHR software, then don’t. Take the energy you’d have spent replacing your EHR and make a deeper investment in optimizing your current EHR usage. That investment will pay off far more than an EHR switch.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re just now starting down the road of the EHR replacement cycle. Meaningful use has driven many to adopt an EHR too quickly and now the buyer’s remorse is setting in and we’re going to see a wave of EHR replacements. Some organizations are going to wait until meaningful use runs it course, but many won’t even be able to wait.

For example, in the whitepaper, Allscripts provides a list of questions to consider when looking to replace your EHR:

How do you DEPLOY the right core IT systems to succeed with value-based care?

How do you CONNECT to coordinate care with key stakeholders and manage your population?

How do you better ENGAGE patients in their own health?

How do you analyze mountains of raw data to ADVANCE patient and financial outcomes?

How do you get everyone within your own organization to FOLLOW THE ROADMAP to EHR success?

You can see that these questions share a certain view of where healthcare IT and EHR is headed. Imagine how this criteria would compare with the criteria for EHR selection even five years ago. Although, I wonder how many doctors really share this type of approach to EHR selection. Do doctors really want their EHR to handle the above list? Should they be worrying about the above items?

I don’t doubt that doctors are going to be more involved in population health and they’re going to need to engage patients more. However, this list does seem to lack some of the practical realities that doctors still need from their EHR. In fact, as I write this, I wonder if it’s still too early to know what a next generation EHR will need to include. Of course, that won’t stop frustrated EHR users from replacing their EHR just the same.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There was a lot of interesting response to my article on replacing an EMR. I actually got an email response that I believe is a really interesting read about one EMR vendors take on the challenges of converting the data from an old EMR to a new EMR. Here’s the email response (with old EMR vendor name removed since it could have been any EMR):

Interesting article. This is where I live each and every day.

Most recently, I’ve switched a client from [current EMR Vendor] to our product Red Planet. The price tag on upgrading [current EMR Vendor] was too prohibitive and they were already familiar with us since we were doing the PMS. So, we already had a foot in the door.

There were two challenges: 1) Converting the data. 2) Converting the culture.

The data was not easily accessible, even through it was SQL based. It was just hand-to-hand combat learning where/how the data was stored and then extracting. The real issue is that you don’t know that you got all of it. You bring up a visit on the new system, and it looks complete until you read some of the fine detail and discover it dropped the last 1/5 of a sentence. I’d scratch my head, go back and do extensive research, find the culprit, run another conversion and we would inch forward. This was extended over a 6 month period. It isn’t like converting a PMS where you know the receivables is X dollars and you can balance to the penny. There is no equivalent “penny” in the EMR and no one has the time to look at every nook and cranny of every note, shot record, lab result, image, or order. So when it looks close, you go for it.

An EMR imposes a culture on an organization. The staff, for instance, would continually ask me how they “suspend” a note so someone else could work on it. “Well, in Red Planet, we don’t do a suspend. There is no need,” would be my response. They would shake their heads, and try to wrap their minds around this new concept. I would watch them do things on their old system that I thought were tedious, non-intuitive, and very prone to error. I would then show them things in Red Planet and they would say to me it was tedious, non-intuitive, and very prone to error.

Now, when they were right about something being cumbersome, I at least have the ability to re-tool a process or function. In the end I’ve been able to capitalize on the things that were good from [their old EMR Vendor] and enhanced our product. I’m a fanatic for speed and accuracy, so being superior to what they had is an obsession.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I received the following email from a reader of this blog:

I am the manager of a 2 physician, 2 nurse practitioner practice with an 11 bed sleep lab. We purchased our EMR in 2006, without much research, because it was compatible with our billing/scheduling program. It is grossly time consuming. Just entering a problem list takes 5 steps (for each disorder we are entering). It will not create notes as many EMRs do. We dictate notes to a transcription service and they are uploaded as documents. Basically it is a non-interactive storage unit, much like our paper charts were, except more time consuming. The company has basically told us that they will not be changing the system. The doctors and NPs are nearing revolt at this point because of the time that they spend trying to use this system.

What is your point of view on finding a new EMR? What would the time and mental repercussions be? Is it possible to coordinate billing systems and EMRs from different companies?

My reply was something I thought many on this blog would benefit from:
Thanks for sharing your experience. Unfortunately, it’s a common one.

The good news for you is it sounds like the notes in your current system is basically a document management system that stores your transcriptions electronically. This bodes well for you if you decide you’d like to move to a new EMR system. I say that because it is likely that you’ll be able to get these documents out of your old system and import them into a new EMR system so that your old EMR records are still available in the new EMR. Many EMR companies will work with you on doing just this.

If your current EMR system is worse than paper, then it sounds like change is likely a good choice. What I think you’ll find is the lessons you’ve learned from this first implementation will help you in your next EMR selection and implementation. It’s unfortunate you had to pay that price, but now that you’ve learned you might as well use it to your full advantage, right? In business they call it a sunk cost. It’s time and money already spent. You should base your decisions on changing your EMR on the time and money you’ll have to spend going forward and not costs which you’ll never get back.

It will take some time and money to fix it. However, those people who dislike your current EMR might be ready to commit the time and money needed to find a good EMR to replace what you’re using now. I will also say that I think unhappy workers is worth spending a lot of time and money to fix. An EMR should not start a revolt.

My only caution for you is that you need to take a real serious look at your clinic and ask an important question: Is it the EMR that’s the problem or is it something about our workflow/clinical environment/policies/culture that is the real problem with the system? Obviously, if it’s the former a change of EMR would be good. If it’s the later, then you might as well not change EMR software until you fix those other issues. I’ve often said that implementing an EMR just exacerbates any problems or weaknesses that exist in a clinical environment. It brings them to the surface and makes them hard to ignore.

Yes, there are a number of EMR companies that will work with your current Practice Management System (PMS). I’m someone who believes that if you’re very happy with your current PMS and the reimbursement that you’re getting from it, then it’s certainly a reasonable option to stick with your current PMS and interface it with an EMR company. In fact, there are some companies that are only EMR companies and then interface with various PMS systems. Their philosophy is that they should just focus their time on making an excellent EMR and not divide themselves between EMR and PMS software creation. Basically, they let another company focus on making an excellent PMS (or they’re are already excellent PMS systems out there). One example of this is Medtuity which is where I learned some of these principles. As I look at their product, I can see the advantages of focusing on being the best EMR and not being distracted.

Just know that there are costs associated with managing/supporting an interface between your EMR and PMS. Plus, there are some advantages to having the two integrated. You should weigh those out as you select a new EMR.

This was kind of fun. If you have a question you’d like me to answer, send it to me on my contact form and I’ll see about making it a future blog post.

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ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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